The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter, cohort study in which a population-based sample of 6,500 Caucasian, Hispanic, African-American and Asian-American men and women aged 45-84 with subclinical cardiovascular disease are followed for 10 years to identify factors predictive of progression to overt cardiovascular disease. The MESA study is sponsored by NHLBI and is funded under contract. The MESA-EYE component (refraction and fundus photography) began in September 2002 at the second MESA visit. The aims are to document the presence and severity of retinal microvascular changes (as read from digital retinal photos) indicative of macular degeneration and diabetic retinopathy and to describe their interrelationships with cross-sectional and longitudinal measures of macrovascular disease, including hypertension, diabetes, inflammation, endothelial dysfunction, and various markers of brain structure and function. The visual acuity/objective refraction component will allow us to estimate visual impairment by sex and ethnicity, determine the degree to which impairment could be reduced with better refractive correction, and to correlate visual impairment with fundus photography findings.